Heavy Bupivacaine Research Articles

Intrathecal Morphine versus Morphine-Dexmedetomidine Combination for Postoperative Pain Control After Total Knee Replacement: A Randomized Controlled Trial.

This prospective study aimed to compare the analgesic efficacy and adverse effects of intrathecal morphine, dexmedetomidine, and a combination of both in patients undergoing total knee replacement (TKR). This randomized prospective study was carried out in Tanta university hospital in orthopedic surgery for 6 months on 105 adult patients with American Society of Anesthesiologists Physical Status Class II and III, aged > 50 years, and scheduled for total knee replacement surgery randomly allocated into morphine group received 0.5% heavy bupivacaine plus 0.1 mg of morphine, morphine/ dexmedetomidine group, received 0.5% heavy bupivacaine plus 0.1 mg of morphine and 5 mcg of dexmedetomidine and dexmedetomidine group received 0.5% heavy bupivacaine plus 5 mcg of dexmedetomidine. The time of the first required analgesia, postoperative pain severity, the total dose of morphine, postoperative complication, and the patient's level of sedation were recorded. About half of the patients in the dexmedetomidine group requested first rescue analgesia 6 hours after the operation, significantly shorter than the other two groups. On the other hand, the other two groups show no significant difference between them regarding the first required analgesia. At rest, the dexmedetomidine group have significantly higher VAS with a significant increase in patients who required morphine as rescue analgesia than the other two groups. While at movement, patients in the dexmedetomidine group felt pain at 4 hrs postoperatively with significantly higher VAS than the other two groups. At the same time, the sedation score was significantly lower in the dexmedetomidine group than in the other two groups. 22.2% of cases in the morphine group developed nausea and vomiting with a significant difference between the three groups. Despite the absence of substantial side effects, our findings did not suggest enhanced analgesia with the combination of intrathecal morphine and dexmedetomidine.

COMPARISION OF DIFFERENT DOSES OF CLONIDINE ADDED TO INTRATHECAL BUPIVACAINE IN ORTHOPEDICS SURGERY

Background: Intrathecal Clonidine is a very safe nonopioid adjuvant to local anaesthetics to prolong the duration of analgesia without any major side effects. Objective: The purpose of the present study is to evaluate the “ COMPARISION OF DIFFERENT DOSES OF CLONIDINE ADDED TO INTRATHECAL BUPIVACAINE IN ORTHOPEDICS SURGERY” Material &Method: ATotal of 60 aduit patients scheduled to undergo lower limb sugeries were ramdonly allocated into either of two group of 30 pateints. Group A: Bupivacaine heavy (0.5%) 2.5ml +30mcg Clonidine, total volume 2.8 ml Group B: Bupivacaine heavy (0.5%) 2.5ml +45mcg Clonidine, total volume 2.8 ml Onset & duration of sensory blockage, Degree of motor blockage, Degree of sedation, Intraoparative heamodynamics. Side effect or any other complication were noted. Result: The mean time of onset of sensory & motor block was less in higher dose added to bupivacaine . The Duration of sensory blockage was signicantly prolonged in Group B 367.26±36.60 min as compared to Group A 200.13±15.70 min . The Duration of motor blockage was signicantly prolonged in Group B 227.86± 22.49min as compared to Group A 176±12.91 min. Conclusions: The addition of intrathecal clonidine 30mcg to small dose of bupivacaine increased the spread , duration of analgesia, & produced effective spinal anesthesia with stable heamodynamis.

Thoracic Spinal Anesthesia for Laparoscopic Cholecystectomy: An Observational Feasibility Study.

The expanding horizons of the application of Segmental Thoracic Spinal anesthesia in day-to-day anesthesia practice prompted us to perform this study in a large subset of healthy patients with the aim of determining the feasibility, safety, advantages, and complications of this mode of anesthesia. The prospective observational study was conducted from April 2020 to March 2022, 2.146 patients with symptoms of cholelithiasis and planned for laparoscopic cholecystectomy were included in this study, and 44 patients from this study were excluded due to pre-defined exclusion criteria. The patients belonging to ASA lIl, lV, severe cardiovascular or renal disability, on beta blockers, coagulation anomaly, spinal deformities, or previous spine surgeries were not included in the study. The patients exhibiting allergy to local anesthetics, requiring more than two attempts for the procedure, patchy or inadequate effects after spinal anesthesia, or change in the plan of surgery intraoperatively were also excluded from the study. All other patients were given subarachnoid block at T10-T11intervertebral space with 26G Quincke needle and Inj. Bupivacaine Heavy (0.5%) 2.4 mL with 5µg of Dexmedetomidine. Intraoperative parameters, number of attempts, the incidence of paresthesia during the procedure intraoperative and postoperative complications, and patient satisfaction were evaluated and recorded. Spinal anesthesia was successful in 2,074 patients and was achieved in a single attempt of procedure in 92% of patients. The incidence of paresthesia during needle insertion was 5.8%. Hypotension was observed in 18% of patients, bradycardia (13%), and nausea (10%) in a few patients, with shoulder tip pain in only 6% of patients. The majority of patients (94%) were "very satisfied" with the procedure. There were no episodes of any adverse event during the postoperative period. Thoracic spinal anesthesia is a regional anesthesia technique practically feasible for healthy patients undergoing laparoscopic cholecystectomy with a manageable incidence of intraoperative complications and no evidence of any neurological complications. It has the advantage of providing manageable hemodynamics, minimal postoperative complication, and an acceptable degree of patient satisfaction.

Effect of addition of intrathecal preservative free magnesium sulfate with 0.5% bupivacaine heavy and fentanyl with 0.5% bupivacaine heavy on post-operative pain relief in patients undergoing hysterectomy

Background: Spinal anesthesia is the most common neuraxial anesthesia for infraumblical surgeries. The use of various adjuvants has become popular in today’s scenario to enhance its quality. Aims and Objectives: The aim of this study was to evaluate the onset, duration of sensory and motor block, hemodynamic effects (if any), duration of post-operative analgesia, and adverse effects of fentanyl or magnesium given intrathecally with 0.5% bupivacaine heavy in patients undergoing hysterectomy. Materials and Methods: This prospective randomized double-blinded study was conducted in total sixty patients undergoing hysterectomy, divided into two groups of 30 patients each. Group F received 25 μg fentanyl with 3 mL 0.5% bupivacaine heavy and Group M received 100 mg magnesium sulfate with 3 mL 0.5% bupivacaine heavy. The onset and duration of sensory and motor blockade, duration of analgesia, hemodyamics, and side effects were assessed. Results: The mean time of onset of sensory and motor block was less in fentanyl (P<0.001). Duration of sensory, motor block, and duration of analgesia was more in fentanyl group (P<0.001), whereas incidence of side effects such as bradycardia, hypotension, and shivering was less in magnesium. Conclusion: Our study concluded that addition of fentanyl as adjuvant effectively augmented the quality of spinal anesthesia, but magnesium provided stable hemodynamics and lesser side effects as compared to fentanyl.

EVALUATION OF INTRATHECAL DEXMEDETOMIDINE ADDED TO BUPIVACAINE FOR LABOR ANALGESIA

Background And Aims: The aim of this study was to evaluate the effectiveness of intrathecal dexmedetomidine with bupivacaine for labor analgesia by assessment of onset, duration and quality of analgesia and neonatal outcomes. Method: In this study 40 eligible parturient who received dexmedetomidine 5 g and heavy bupivacaine 0.5% 2.5 mg diluted upto 2.5 cc with sterile NS intrathecally for labor analgesia were selected. The time of onset, duration and quality of analgesia were noted. Maternal parameters pulse rate, systolic blood pressure, motor block and side effects of pruritus, nausea, vomiting, hypotension and headache were recorded. Neonatal outcomes in terms of mode of delivery and APGAR score were noted. If VAS >3, analgesia was supplemented with epidural bupivacaine 0.125% 10 ml during labor. For rescue analgesia, Inj. Tramadol 1 – 2 mg/kg iv was given as per institutional protocol if the patient VAS score was still more than 3 even after second dose of epidural. Result: Mean time for onset of analgesia was 2 minutes (VAS<3). All parturient had VAS < 3 throughout the labor. Mean duration of Labor was 99.4 ± 48.35 min. Total duration of labor ranges from 45 minutes to 210 minutes in our study. Most 92.5% of parturient had maximum motor blockade of grade 1 and it was lasted maximum upto 30 min. Hypotension was observed in two parturient and one parturient had nausea, which responded to conservative management. The mean APGAR score at 1 min was 8.85 ± 0.97 and at 5 min it was 10 (excluding LSCS delivery). Out of 40 total, 30 parturient have graded labor analgesia as excellent and rest have graded as good. Conclusion: Dexmedetomidine (5μg) seems to be a safe and efcacious adjuvant to intrathecal bupivacaine 0.5% (2.5 mg) in women undergoing vaginal delivery. This may be helpful for parturient coming late to the delivery room, seeking rapid onset with good quality of analgesia

A CASE OF SYSTEMIC LUPUS ERYTHEMATOSUS FOR CAESEREAN SECTION

Introduction : Systemic Lupus Erythematosus is a chronic multisystem disorder characterized by formation of autoantibodies against nuclear , cytoplasmic and cell membrane antigens . Most common in women of child bearing age group . Disease exacerbation , neonatal lupus , fetal loss and increased incidence of pre-eclampsia are major challenges. Case Report : A 26 year old woman G3P1L0A1D1 with 39 weeks amenorrhea with known history of SLE since 2 years scheduled for elective LSCS . She has bad obstetric history and on medication with Tab.Azathioprine 50mg OD , Tab.Hydroxychloroquine 200mg OD and Tab.Prednisolone 5mg BD. ANA antibodies were found to be positive but antiphospholipid antibodies were negative. Regional anaesthesia preferred over general anaesthesia because of anticipated difcult airway. Subarachnoid block performed using 2ml of 0.5% bupivacaine heavy . Surgery uneventful with minimum blood loss. Discussion ;The peak incidence of SLE occurs between the ages of 15 and 40 years, with an estimated female-to-male incidence of 9:1. It is characterized by autoantibody production and dysfunctional immune system resulting in organ inammation andconsequent damageSLE may be associated with secondary APS which is a multisystem disorder characterized by recurrent systemic arterial and venous thrombosis, recurrent abortion, thrombocytopenia and neurological disorders Musculoskeletal manifestations and mucocutaneous symptoms occur frequently. Anaesthetic management of pregnant patients with SLE depends on the multisystem nature of the disease, the severity of the organ involvement and adverse effects of drugs used in treatment. Conclusion : Anaesthetic management of SLE requires thorough pre anaesthetic evaluation regarding organ involvement , disease activity and drug history . Pharmacological interactions between anaesthetic drugs and immunosuppressants taken into consideration

Measurement of the Outcome of Low Dose of 0.5% Bupivacaine Heavy in Spinal Anesthesia during Lower Segment Cesarean Section (LSCS)


 Background: Spinal anesthesia for lower segment cesarean sections is not without its challenges for anesthesiologists, such as severe hypotension from too much bupivacaine or insufficient anesthetic from too little.
 Objective: In this study our main goal is to measure the efficacy of low dose of 0.5% Bupivacaine in spinal anesthesia during lower segment cesarean section.
 Methods: This investigation was conducted at a tertiary medical institution as a cross-sectional comparison study between January 2020 and January 2021, where one hundred pregnant ladies participated.
 Patients who volunteered to take part in the trial were randomly split into two groups: Group A got an intrathecal injection of 3 mL of bupivacaine 0.5% (n=50), while Group B received an intrathecal injection of 2.5 mL of bupivacaine 0.5% (n=50). Tossing a coin was used as a randomizer. The patient's heart rate, blood pressure, and oxygen saturation were taken before receiving anesthesia. Each patient underwent a subarachnoid block (SAB) using a 25-gauge Quincke spinal needle using a midline route after being preloaded with 800 ml to 1000 ml of isotonic intravenous fluid. The entire process of injecting the hyperbaric bupivacaine took no more than twenty to thirty seconds.
 The needle's bevel was aligned with the dura's fibers. All of the data was entered into SPSS-25 after being coded. Statisticians used both descriptive and inferential methods. Percentages, means, standard deviations, graphs, tables, figures, and inferential statistics were all part of the descriptive statistics.
 Results: Most participants were between the ages of 26 and 33, and between 60% and 70% were multiparous over the course of the research.
 In both groups, all patients were able to reach a suitable sensory level for surgical intervention, as shown below. However, ephedrine was advised for 89% of Group B patients to help stabilize their blood pressure, whereas only 19% of Group A patients needed ephedrine. There were no significant variations in fluid consumption (P > 0.05) between Groups A and C (894 126 mL vs. 720 212 mL). The newborn's Apgar score was 9 at 1 minutes and 10 at 5 minutes. Also, although 19% of people in group A reported feeling sick, 23% of people in group B did.
 Conclusion: A lower segment cesarean section performed under an optimal dose of hyperbaric bupivacaine in the spinal anesthesia will produce excellent surgical conditions with little hypotension, in contrast to the low dose. Improved results require more research..

Height-adjusted dose of intrathecal bupivacaine on surgical anesthesia for the cesarean section

Background: In the spinal anesthetic technique, local anesthetic dose (concentration and volume) is the main determinant of its adequacy and success of block to be achieved. The lack of pain during surgical intervention rather than on dermatome sensory block level is considered to be an appropriate indicator of surgical anesthesia. Spinal anesthesia is the most common anesthetic technique to provide anesthesia for the elective or emergent cesarean section (CS). However, spinal block-induced maternal hypotension is the most common adverse effect during single-shot spinal anesthesia. In our study, we aim to study the height-adjusted dose of 0.5% Bupivacaine Heavy (BH) in achieving surgical anesthesia and its effect on maternal hypotension. Participants and Method: One hundred parturients scheduled for elective CS were enrolled and were compared to the parallel arms of parturients receiving conventional BH. Fifty parturients in each group were included. In the conventional group (B), participants received spinal block with 12 mg of 0.5% BH, and in the height adjusted-dose group (H), participants received a dose of 0.5% BH in 0.06 mg per centimetre height. A sensory block level of T6 dermatome or higher was consider adequate to start surgery. The adequate surgical anesthesia is considered to be achieved if cesarean delivery can be performed without supplementary analgesia. The need of supplementary analgesia, conversion to general anesthesia, or no block till 15 min of intrathecal BH is considered spinal failure. Results: 4% of the height-adjusted dose group have a low block level. Two cases complained of pain, and of them, one received supplementary analgesia and one was converted to general anesthesia. Systolic hypotension of a maternal blood pressure of less than 90 mm Hg was found in 19 (38%) and 10 (20%) in the conventional group and HAD group, respectively, which was highly significant statistically (p value 0.001%). Conclusion: Intrathecal hyperbaric bupivacaine in height adjusted 0.06 mg per cm height of patient can achieve surgical anesthesia with maintainance of systolic blood pressure. However, low dosing of intrathecal BH has higher cases of block failure in comparison to the conventional fixed dose regime of spinal anesthesia.

Opioid-free Anaesthesia and Analgesia in a Sickle Cell Disease Patient with Extensive Orthopaedic Soft-tissue Surgery

The provision of anaesthesia through techniques devoid of opioid is referred to as opioid-free anaesthesia. Both pain crisis in sickle cell (SC) disease and poor postoperative pain care worsens patient morbidity. This is a case report of a 22-year-old female SC anaemia patient, who had bilateral quadricepsplasty. Sickle Cell disease is common among individuals of African race and opioids are often abused during the out-of-hospital treatment of pain crisis. We report the case of pentazocine addiction resulting in severe bilateral quadriceps fibrosis. Thus, it was necessary to avoid opioid-based anaesthesia. A combined spinal epidural anaesthesia using magnesium adjunct was applied. The analgesic function of magnesium is linked to the blockade of the N-methyl-D-aspartate receptor. The subarachnoid block was achieved with 3.5 mL of 0.5% heavy bupivacaine (17.5 mg), while epidural anaesthesia was done with 14 mL of 0.25% plain bupivacaine (37.5 mg) and 1 mL of 2 mg/kg of magnesium, (i.e., 120 mg). After the surgery, the surgical sites were infiltrated with 10 mL of 0.25% plain bupivacaine (25 mg) on each limb. Intravenous magnesium-sulfate 5 mg/kg (i.e., 300 mg), was added to 500 mL of crystalloids to run every 4 h. Furthermore, 1 mL of 2 mg/kg magnesium, (i.e., 120 mg,) was added to the 14 mL of 0.125% plain bupivacaine to make 15 mL of magnesium–bupivacaine admixture, every 4 h. These were given for 48 h. The Visual Analog Scale pain scores reduced from 9/10 to 5-6/10 and then to 3/10 over a 6-h period and remained at or lower than 3/10 throughout the postoperative period. Adequate haemodynamics, oxygenation, hydration, warmth, and urine output were ensured. The postoperative period was crisis free.

Comparison of two different doses of magnesium sulfate as an adjuvant to intrathecal bupivacaine in patients with pre-eclampsia undergoing elective cesarean section: A prospective double-blind randomized study

Background: Intrathecal magnesium sulfate is now emerging as a safe and effective adjuvant for spinal anesthesia (SA). The aim of the present study was to compare the efficacy of two doses of intrathecal magnesium in parturients with pre-eclampsia. Methods: This prospective randomized double-blind study was conducted on 105 parturients undergoing elective cesarean section (CS) who were randomized into three groups of 35 each: Group C, M50, and M75. Group M50 and group M75 received 50 mg of 50% (0.1 ml) and 75 mg of 50% (0.15 ml) magnesium sulfate, respectively. All of the groups received 10 mg of 0.5% heavy bupivacaine with normal saline accordingly to make a total volume of 2.2 ml. The sensory and motor block characteristics, visual analogue scale (VAS) score, post-operative analgesic requirements, hemodynamic parameters, and adverse effects were compared. Results: The sensory and motor block characteristics were significantly delayed in group M75 compared to group M50 and the control group (P < 0.05). VAS scores were significantly high in the control group up to 6 h as compared to group M50 and group M75 (P < 0.05). The time to first rescue analgesia was significantly extended in group M75 (222.86 ± 12.502 min) as compared to group M50 (221.14 ± 13.671 min) and the control group (127.43 ± 11.464 min) (P < 0.05) Conclusion: Intrathecal magnesium sulfate at doses of 50 mg and 75 mg in pre-eclamptic parturients undergoing elective CS results in prolonged duration of analgesia, decreased VAS scores and also delays the first rescue analgesic requirement with a favorable adverse effect profile in terms of decreased incidence of nausea and shivering.

Comparison of intrathecal bupivacaine with different doses of clonidine for spinal anesthesia in adults: A systematic review

Background: Evaluating the optimal dose of intrathecal clonidine adjuvant has a great impact on day-to-day practice of anesthesia, as spinal anesthesia is one of the most commonly performed anesthetic procedure.Objectives: Evaluate for the minimal dose of intrathecal clonidine as an adjunct to bupivacaine heavy for spinal anesthesia that can produce optimal sensory and motor blockade with minimal hemodynamic effects.Methods: Randomized control trials carried out on adult patients, of both genders undergoing elective infraumbilical surgeries under spinal anesthesia with bupivacaine heavy and different doses of clonidine having ethical committee approval were included and articles published in non-English languages were excluded. Databases (PubMed and Google Scholar) and websites of the Indian Journal of Anaesthesia and anesthesia essays and researches journals were systematically searched and interpreted in accordance with the PRISMA guidelines. Quality assessment was done using the Risk of Bias assessment 2.O tool. The mean time taken for the onset of sensory and motor blockade, mean duration of sensory and motor blockade and significant adverse effects were the key outcome variables. Nonstatistical synthesis of quantitative data of the selected articles was done.Results: The efficacy in terms of sensory and motor blockade was comparatively more with 1 μg/kg of intrathecal clonidine than with lower doses, however, cardiovascular adverse effects were dose-dependent, with 15 μg intrathecal clonidine causing least cardiovascular disturbance.Conclusion: 15–30 μg intrathecal clonidine as an adjunct to bupivacaine heavy would produce optimal sensory and motor block with minimal hemodynamic disturbances.

Cesarean section in Swyer-James-Macleod syndrome: Anesthesia implications.

Dear Editor, Swyer-James-MacLeod Syndrome (SJMS) is a rare, acquired postinfectious condition characterized by bronchiectasis or emphysematous changes.[1,2] These patients have a high risk of perioperative pulmonary complications. A 28-year-old primigravida, at 24 weeks of gestation, came with dyspnea on exertion (grade-3) for the 3 months with no history of recurrent infections. On examination, there was diminished breath sounds on the left side. Chest radiograph (done with abdominal shield) showed left hyperlucent lung with reduced vascular markings and slight mediastinal shift. Rest of the investigations were normal. The patient was referred to chest physician for optimization and a diagnosis of Swyer-James syndrome with left lung bulla/pneumothorax was made. The patient was managed with bronchodilators (Metered-Dose Inhaler levosalbutamol and Tiotropium bromide) and breathing exercises (pursed-lip breathing, diaphragmatic breathing). Spirometry was not done since the patient was in the second trimester of pregnancy. The patient got symptomatically better and an elective cesarean section was planned. Blood gas analysis performed a day before surgery showed PH: 7.441, PCO2:25.6, PO2 = 70.6, Bicarbonate = 17, Base excess = 7.21, Oxygen saturation = 94.4%. High-risk written consent was taken and expected complications were explained. On the day of surgery, the patient was taken in the operation theatre after giving inhalational bronchodilators. Ondansetron 4 mg and ranitidine hydrochloride 50 mg were given intravenously 30 min prior to surgery. A 20-G intravenous cannula was secured, Ringer lactate was started and vital parameters were monitored. Spinal anesthesia with 10 mg of heavy bupivacaine and 25 micrograms of fentanyl in the right lateral position was given. The intraoperative period was uneventful. SJMS was first described in 1953 by Swyer and James, and later explained in detail by MacLeod. A chest radiograph demonstrates lobar or unilateral hyperlucent lung and normal or reduced volume of the affected lung. Patients can present with a multitude of symptoms ranging from asymptomatic with incidental radiographical diagnosis to severe symptoms such as dyspnea and repeated pulmonary infections.[1,2] This syndrome is usually diagnosed in childhood after an evaluation for recurrent respiratory infections, but sometimes they are asymptomatic and may be diagnosed in adulthood.[3,4] In a case series by S. S. Hadice et al.,[3] three out of four patients had no history of airway infection in childhood and were diagnosed in adulthood. The clinical incidence of SJMS in pregnancy is 1:2500.[2] The management focuses on early diagnosis, prevention, and treatment of recurrent pulmonary infections and vaccine administration.[2–4] Severe cases of SJMS may require anesthetic care cautiously tailored to significant obstructive pulmonary physiology.[5] Regional anesthesia should be preferred whenever feasible. Chopra S et al.,[2] reported the successful delivery in a case of SJMS under spinal anesthesia in emergency. Labor epidural anesthesia can also be used in electively scheduled patients and supplemented with low-dose spinal anesthesia before surgery, if required. General anesthesia is associated with risk of bulla rupture, worsening of pneumothorax, and other pulmonary complications. Drugs that can cause histamine release and bronchoconstriction should be avoided. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient and her father have given their consent for his images and other clinical information to be reported in the journal. The patient and father understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Comparison of fractionated versus bolus dose of bupivacaine heavy (0.5%) in spinal anesthesia for elective caesarean section—A prospective, randomized, single blind, and clinical trial

Comparison of fractionated versus bolus dose of bupivacaine heavy (0.5%) in spinal anesthesia for elective caesarean section—A prospective, randomized, single blind, and clinical trial

Clinical evaluation of perfusion index (PI) as a predictor of post spinal hypotension in lower segment caesarean section (LSCS)

Hypotension is a common complication, subsequently spinal anaesthesia in lower segment caesarean section, which can cause adverse maternal &amp; foetal outcomes. A new decisive research area in obstetric anaesthesia is prevention &amp; early treatment of spinal hypotension to improve maternal &amp; foetal outcomes. A novel parameter, Perfusion index (PI) is tried during sub arachnoid block for predicting hypotension in lower segment caesarean section (LSCS). In this study, 60 parturient belonging to ASA status 1 or 2 with apparent pregnancies scheduled for elective LSCS received spinal anaesthesia with 2ml of 0.5% heavy bupivacaine by using an orange (25G) Quincke needle at L3-L4 or L4-L5 interspinous space. Haemodynamics &amp; perfusion index were recorded at regular intervals. Baseline perfusion index was correlated with degree of hypotension by using Receiver Operative Characteristic curve. Baseline perfusion index &amp; other parameters were correlate by Karl Pearson correlation method. : In our study 34.5% incidence of hypotension among study theme &amp; momentous correlation between fall in systolic blood pressure from baseline &amp; baseline perfusion index (r = 0.436; P &amp;#60; 0.05). The optimal utmost point for perfusion index was found to be 3.5 with a sensitivity of 37% &amp; specificity of 97%. A higher incidence of hypotension was found in Parturient having baseline perfusion index more than 3.5 following sub arachnoid block in elective LSCS.

Comparison Study Of Intrathecal 0.75% Ropivacaine Heavy Versus 0.5% Bupivacaine Heavy For Safety &amp; Efficacy Of Patients Posted For Elective Lower Abdominal Surgeries: A Randomized Comparative Study

Introduction: This study was designed to evaluate the safety and efficacy of Intrathecal Ropivacaine and Bupivacaine , who are posted for elective surgery under regional Anesthesia.&#x0D; Method: After getting approval from the institutional ethical committee and informed consent from patients. 100 patients scheduled for various lower abdominal surgeries. All patients were selected based on ASA 1&amp;2. Patients are randomly selected in two groups (R&amp;B). Group-R n=50, received 0.75% Ropivacaine heavy Group-B n=50, received 0.5% Bupivacaine heavy.&#x0D; Inclusion criteria: Both Gender, ASA 1&amp;2, Age 20-60, Elective lower abdominal surgeries.&#x0D; Exclusion criteria: Patient refusal, Emergency surgeries, Local sepsis at site of injection.&#x0D; Characteristics: In our study, we compared patient with regard to Age, Weight, Height, ASA status, Motor and sensory blockage.&#x0D; Discussion: The purpose of this study is to evaluate the safety and efficacy of Intrathecal Ropivacaine in comparision with Bupivacaine. We evaluated the Motor and sensory block characteristics. Ropivacaine showed slow onset, slightly faster motor regression than sensory . Total time for sensory regression has been prolonged in Ropivacaine than Bupivacaine in our study.&#x0D; Conclusion: In our study, the sensory block achieved was maximum with Ropivacaine compared with Bupivacaine. Onset of motor block was rapid in Bupivacaine when compared to Ropivacaine. This study showed that Ropivacaine has lower level of cephaled spread of sensory block, but it takes more time for regression of sensory block compared to motor block. Urinary retention is more with Group-B than Group-R. Hemodynamic stability was better with Ropivacaine compared with Bupivacaine.

Anesthetic management of cesarean sections in coronavirus disease 2019 patients at our coronavirus disease center

Coronavirus disease 2019 (COVID-19) is a contagious pulmonary infectious disease with respiratory symptoms. The virus, SARS-CoV-2 has shown 85% resemblance to SARS coronavirus (SARS-CoV) and MERS coronavirus (MERS-CoV). The management of a COVID-19 positive mother is challenging as the virus is extremely contagious and can be life threatening to mothers and health-care personnel. Here, we describe the successful anesthetic management of 20 pregnant women with confirmed COVID-19 infection undergoing cesarean section in our hospital. A dedicated operating room was used for cesarean delivery of a parturient with COVID-19. This dedicated operating room was located in the secluded area of our hospital, away from the rest of the operating rooms. The first choice of anesthesia was a single-shot subarachnoid block with 0.5% heavy bupivacaine.

Subarachnoid lavage following inadvertent intrathecal injection of tranexamic acid

Tranexamic acid (TXA) is a commonly used antifibrinolytic drug during surgical procedures to reduce blood loss. An Inadvertent intrathecal injection of TXA may lead to serious side effects including seizures and ventricular fibrillation with reported fatalities. We report a case of an inadvertentintrathecal injection of TXA which occurred as a result of similarities in appearance between TXA and heavy bupivacaine ampoules. The patient had subarachnoid lavage after experiencing back pain, systemic hypertension followed by generalized tonic clonic seizures.

A Comparison of the Injection Rate of Local Anesthetic during Spinal Anesthesia on the Onset of Sensory Block and Incidence of Hypotension in Caesarean Section

Objective: The injection rate of the local anesthetic may affect the level and the time of onset of sensory block. The aim of this prospective study was to investigate the effects of two different injection rates of local anesthetic solution (0.5% heavy bupivacaine) on the onset of sensory block, and the incidence and the onset of hypotension in pregnant women undergoing spinal anesthesia for elective Cesarean delivery. Methods: A total of 67 patients were randomized into two groups: 120-second injection time (Group Slow; n = 33) and 15-second injection time (Group Fast; n = 34). Maximum level of sensory and motor block, time to sensory block at the level of T6, hemodynamic parameters, use of ephedrine and incidence of side effects were recorded at measurement time points. Results: Maximum level of the sensory block was similar in both groups. The time to achieve adequate and maximum sensory block level was shorter in Group Slow(S) (p = 0.004 and 0.037, respectively). Incidence of hypotension was similar, but hypotension occurred earlier in Group Fast(F) (p = 0.011). Requirement for ephedrine and incidence of nausea and vomiting was similar. Conclusions: This study reveals that 120-second injection duration during spinal anesthesia is associated with shorter time to achieve the maximum sensory block level and slower onset of hypotension. It means that prolonging the duration of local anesthetic injection to 120-seconds is advantageous compared with 15-seconds in caesarean section.

POST OPERATIVE ANALGESIA AFTER SPINAL ANAESTHESIA WITH MORPHINE AND BUPIVACAINE VERSUS FENTANYL AND BUPIVACAINE FOR UNILATERAL INGUINAL HERNIA REPAIR IN ADULT MALE : A COMPARATIVE STUDY

Background: The study is aimed to compare the effects of intrathecal fentanyl and intrathecal morphine combined with 0.5% hyperbaric bupivacaine on the quality of postoperative pain control for unilateral inguinal hernia repair in adult male population. Fifty –ve patients aged 18-60 years with American Society of Anesthesiologists physical status I-IIMaterials and Methods: scheduled for elective inguinal hernia repair surgery were enrolled in this prospective randomized double blinded study. Patients received spinal anesthesia with either 25 mcg fentanyl plus 15 mg heavy bupivacaine intrathecally (group F, n=55) or 0.2 mg morphine plus 15 mg heavy bupivacaine intrathecally (group M, n=55).Hemodynamic parameters, time to rst analgesic requirement, postoperative pain scores, the number of analgesic requirements and side effects over postoperative 24 h were recorded Pain scores were signicantly lower in group MResults: compared with group F in the postoperative 24 h. The time to rst analgesic requirement was higher in group M than group F. Analgesic requirement was higher in group F than group M for the rst 24 hours, postoperative We concluded that the addition of 0.2 mgConclusion: morphine intrathecally to 15 mg heavy bupivacaine provides improved postoperative analgesia than 25 mcg fentanyl for inguinal hernia repair under spinal anesthesia.

Comparison of nalbuphine and fentanyl as adjuvants to bupivacaine in unilateral spinal anaesthesia in patients undergoing lower limb orthopaedic surgeries

Unilateral spinal anaesthesia is a technique used to avoid hemodynamic changes and early recovery. Adjuvants are added to prolong post operative analgesia, this study was done to compare nalbuphine (0.8mg) and fentanyl (20µg) as adjuvants to 0.5% bupivacaine Heavy in unilateral spinal anaesthesia for patients undergoing lower limb orthopaedic surgeries. Randomized double blind study in patients posted for lower limb orthopaedic surgery in a teritiary care center.Unilateral spinal anaesthesia was given to 68 eligible patients undergoing lower limb orthopaedic surgery with nalbuphine (0.8mg) and fentanyl (20µg) as adjuvants to 0.5% bupivacaine Heavy. Block characterstics, unilaterality, hemodynamic changes and recovery were noted. Independent sample t-test was used to compare continuous variables with normal distribution and chi square test for categorical variablesUnilateral block was seen in 60 of 68 patients enrolled. Time to achieve T 10 level was comparable between both the groups in nalbuphine and fentanyl group (4.33±0.99 and 4.77 ± 0.89 respectively). Duration of sensory block was significantly lesser in nalbuphine group as compared to fentanyl group (170.67±15.34 and 178.83±15.04 respectively). However, there was no significant difference in duration of analgesia, 265.17 ± 17.73 in nalbuphine group and 260.23 ±31.03 in fentanyl group (p=0.45).Nalbuphine due to its easy availability can be used as effective alternative to fentanyl as adjuvant in unilateral spinal anaesthesia.